1. Field of the Invention
This invention relates to critical care transport apparatus, and more particularly, to improved patient transportation apparatus used to transport critically ill children from the field to a nearby hospital, or between hospitals, by way of airplane, helicopter, or ground ambulances.
2. Background of the Invention
Emergency patient care of the type discussed herein, generally is that dispensed by rescue squad crews aboard light planes, helicopters, and ground ambulances. Further, the usual rescue situation will involve extraction of an infant or child from a remote location after receiving a critical injury.
It is customary for those skilled in this art to refer to a field device for supporting a patient in a horizontal transporting position as a stretcher. Devices in which patient transportation function is performed by two individuals carrying the device and patient are known as litters. While the pediatric critical care transport system of the present invention may be used as both a stretcher and a litter, all further references herein will be to a "stretcher".
Stretchers have a long been a standard adjunct to ambulatory care vehicles. So-called "ambulance stretchers" have become generally standardized in their dimensions. In recent years, ambulance stretchers have been equipped with permanently attached treatment equipment, such as heart-lung resuscitating devices, heart monitoring and ECG recording devices, defibrillating devices, and the like. These stretcher systems have served to expand the treatment capabilities to the patient at the location of injury, but at the same time, the systems of this type are invariably larger than standard ambulance stretcher dimensions. Such stretcher systems are not only increased in size in comparison with ambulance stretches, but in total weight as well. Consequently, movement of these systems when fully burdened may easily require up to four persons.
Further, movement of such enlarged systems to and from ambulatory care vehicles are restricted by their size. This is particularly apparent in situations where access to the patient requires movement of the system up and down stairways, along restricted openings, etc. When the transport environment includes a light aircraft or helicopter, the transport space involved is significantly reduced from that of a traditional ambulance. Thus, the patient must first be transported to the ambulatory vehicle before receiving the benefit of medical equipment monitoring, oxygen, etc. Further, upon reaching the destination where advanced critical care may be administered, the transportation crew is faced with making the choice of disconnecting the patient from all instrumentation for rapid evacuation from the ambulatory vehicle, or leaving electrical wires and fluid lines in places, but enlisting additional personnel to manage the equipment. These restrictions are usually enforced by the limited dimensions of the transport vehicle, which preclude accommodating a large stretcher apparatus with permanently attached equipment. Further, in the case of pediatric critical care transport from remote locations, two other difficulties are encountered. First, traditional stretchers are emphasized to accommodate the height and weight of an adult. The attachments for restraining a patient thereon are usually quite adjustable, but insufficient for practical restraint of a very small child. Second, traditional stretcher systems do not anticipate removal of critically injured children from areas where it is very cold. While the injured child may be wearing clothing sufficient for the environment, such clothing must often be removed for access to the injured portions of the body. Restraining wraps used for adults are often much too large for the child, and preclude adequate access to injured areas and areas available for monitoring vital signs. The end result is that critically injured children are often acutely uncomfortable during a time when they are also in great pain. This is because adult-sized transport apparatus necessitates exposure to the elements, including the down-wash of a helicopter which is used for transport.
Rigid stretcher systems also do not accommodate elevation of the patient's head for assistance in clearing the airway or preventing the patient from choking or suffocating on fluid in the mouth.
While some attempts have been made in the past to remove these difficulties, none have successfully integrated stretcher and restraining components into an integrated critical care transport system for infants and small children which accommodates needed critical care instrumentation in a size which enables transport by light planes and helicopters. U.S. Pat. No. 4,060,079, issued Reinhold, Jr. and U.S. Pat. No. 5,494,051, issued to Schneider, Sr. attempt to overcome the unwieldy operation of separate instrumentation and transport apparatus by providing a stretcher with integral instrumentation. However, neither apparatus is sized for use with children, and neither provides any significant elevation in the head. Further, there is no integrated restraint system which provides security, comfort, and protection from the elements.
U.S. Pat. No. 4,534,075, issued to Schnitzler and U.S. Pat. No. 5,481,770, issued to Ahlsten, both disclose a stretcher which allows elevation in the head, but does not provide any accommodation for instrumentation. Further, neither apparatus includes a restraint system appropriate to small children.
U.S. Pat. No. 4,124,908, issued to Burns et al. and U.S. Pat. No. 4,970,739, issued Bradford, teach a stretcher apparatus with integral restraint systems. However, neither of these devices is suitable for elevation of the head, and in fact, both are directed towards immobilization of the patient during spinal injury. Also, neither device provides for integrated or captured instrumentation.
U.S. Pat. No. 5,154,186, issued Laurin et al., discloses a spinal restraint device with the capability of accommodating instrumentation, but does not provide for elevation of the head, and is more specifically directed toward immobilization of the patient.
Therefore, the present invention is directed toward overcoming the transport difficulties encountered in the critical care transport of children as set forth above. It is desirable to have an apparatus which can safely secure the patient during a transport accident. It is also desirable to have an apparatus which allows access to the pediatric patient which allows movement as needed during medical intervention while properly restraining the patient. It is also desirable to have an apparatus which allows positioning the patient to protect the airway by allowing lateral and rotational movement, and even allowing the patient to sit up without modification of the safety restraint system. It is desirable that such a restraint system prevents the patient from being thrown around within, or out of the transport vehicle during an accident, and that such a restraint system be designed to avoid stress points and thereby significantly reduce the chance of causing additional injury during an accident.
Further, it is desirable to have a pediatric critical care transport system which provides protection from the extremes of the environment during the transport process. It is also desirable that the environmental protective restraint system allow access to the patient, while permitting comfortable and secure restraint, which decreases the psychological terror induced by using a "belt-only" system.
Further, it is desirable to provide a pediatric critical care transport system which provides an integrated platform for the attachment of specific devices to monitor the pediatric patient condition. Further, it is desirable to have a system which safely secures the attached monitoring equipment to the stretcher, while presenting the monitoring equipment in a usable position. It is also desirable to have a system which is strong and stable, lightweight, and provides a mechanism to safely and securely retain oxygen and compressed air tanks. It is also desirable to have a system which accommodates attachment of IV pumps and apparatus.
Further, it is desirable to have a pediatric critical care transport system that allows stable on-end storage and dramatically decreases the storage space needed for several similar devices. It is also desirable to have a system which incorporates an open compartment carrier to accommodate multiple brands of mechanical ventilators in a safe, secure, and functional position.
Further, it is desirable to have a pediatric critical care transport system that effectively restrains children and provides a wrap or body enclosure to completely encompass the body of a child to provide thermal protection from the environment, which is especially critical for the small infant, preventing heat loss from the exposed face and head. It is also desirable to have a system which incorporates insulation in the area along the head and ear to decrease the psychological stress of induced noise during aerial transport. It is also desirable to have a system which protects against the down-wash during the "hot loading" to a medical helicopter.
Further, it is desirable to have a pediatric critical care transport system which serves the multiple purposes of safety restraint and enclosure of exposed body sites, while simultaneously padding the patient in those areas subject to restraint. It is also desirable to have a system with the flexibility to accommodate access to IV lines, monitor leads, tubes, catheters, oximetry probes, etc. without loss to the environmental control or patient security or safety restraint. It is also desirable to have a system which is sized appropriately for small children and infants. It is also desirable to have a system in which the patient is protected from exterior heat by fire resistant materials.
Further, it is desirable to have a pediatric critical care transport system that provides restraint over both shoulders of the patient to accommodate sudden deceleration changes. It is also desirable to have a restraint system which effectively prevents the patient from being thrown around the interior of the transport vehicle, while allowing the patient to sit up. It is also desirable to have a system which prevents a single point for connection of shoulder straps and other restraining measures. It is also desirable to have a system which restrains safely, distributing the weight of the patient over a wide area on the body of the critically ill patient.
The pediatric critical care transport system as described herein fills an important need for a small number of high-risk pediatric patients who are undergoing inter-hospital transport, or rescue from a remote site. This type of patient requires protection from the elements, integrated monitoring and support equipment, and safe, comfortable restraint, provided by the present invention.